Pregnant women's likelihood of cesarean delivery in Massachusetts linked to choice of hospitals
There is wide variation in the rate of cesarean sections performed at different hospitals across the U.S. and one explanation has been that hospitals with higher c-section rates serve greater numbers of women at high risk for the procedure. Now, a new study by researchers from Harvard School of Public Health (HSPH) and the Massachusetts Department of Public Health provides the strongest evidence to date that it's not just medical need that determines who has c-sections, but also something at the hospital level—in other words, the same woman would have a different chance of undergoing a c-section based on the hospital she chooses.
The findings suggest that certain hospitals' high rates of cesarean births have more to do with characteristics of the hospitals themselves than with characteristics of their patients.
"Even after taking into account factors that put women at risk of having a c-section, such as age, and pre-existing health conditions, some hospitals still have higher rates of c-section delivery than others," said senior author S V Subramanian, professor of population health and geography at HSPH. Put simply, for two women with a similar observed risk profile, one might have a c-section delivery and one might not, depending on which hospital they go to, he said.
The study appears in the March 18, 2013 online issue of the journal PLOS ONE.
While c-sections can be a lifesaving procedure for an infant in distress, or when there are multiple births or other labor complications, c-sections that are not medically necessary can put mothers and babies at avoidable risk of infection, extend hospital stays and recoveries, and increase health costs. In spite of these risks, c-section rates have been increasing in the U.S. over the past 17 years. Mirroring the national trend, cesarean deliveries in Massachusetts have increased steadily since 1997. In 2009, about one-third of all births in Massachusetts were by c-section—up 61% from 1998.
In 2008, the Massachusetts Department of Public Health invited local clinicians and researchers to partner with state health officials in a study to better understand why c-section rates have been rising in Massachusetts. The HSPH, Boston University, Massachusetts General Hospital, and Massachusetts Department of Public Health team, using data from the Pregnancy to Early Life Longitudinal data system, analyzed 228,864 births in Massachusetts' 49 hospitals with maternity services from 2004-2006—98% of all births during that period.
The researchers found that about 27% of first-time mothers in Massachusetts having single, vertex (head-first) presentation, full-term infants from 2004-2006 had c-sections. C-section rates in Massachusetts hospitals varied from 14% to 38% even among this low-risk group.
Previous research had been unable to offer clear answers on whether variations in hospitals' c-section rates had simply to do with hospitals' different case mix. But the new research findings, say the authors, show with more certainty that a mother's risk of c-section really is influenced by her choice of hospital. "This is the first time that anyone has shown this problem exists right here in Massachusetts, which is widely considered to be one of the world's premier health care hubs," said Mariana Arcaya, research scientist at the Harvard Center for Population and Development Studies and co-author of the study.
The findings suggest that hospital practices and culture are important determinants of a hospital's c-section rate, said lead author Isabel A. Cáceres, who was an epidemiologist at the Massachusetts Department of Public Health at the time of the study. Though this study did not pinpoint which hospital factors were at play, the authors highlighted previous studies suggesting that liability and insurance, being a teaching hospital, hospital admission practices, and the presence of midwives may influence c-section rates. Lack of clinical guidelines or standards on when a cesarean should be performed also may help explain why hospital rates are so variable.
The researchers said that hospitals should re-examine their procedures for deciding when to perform c-sections to make sure that medical need—not other factors such as doctor preferences or fear of liability—determine how babies are delivered.
More information: "Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact," Isabel A Cáceres, Mariana Arcaya, Eugene Declercq, Candice M. Belanoff, Vanitha Janakiraman, Bruce Cohen, Jeffrey Ecker, Lauren A. Smith, S V Subramanian, PLOS ONE: March 18, 2013. http://dx.plos.org/10.1371/journal.pone.0057817
Journal reference: PLoS ONE
Provided by Harvard School of Public Health
- Researchers find wide variation in cesarean delivery rates among US hospitals Mar 05, 2013 | not rated yet | 0
- Too posh to push? The increasing trend for cesarean section May 17, 2011 | not rated yet | 0
- Local efforts can stem the increasing unnecessary cesarean sections Jul 26, 2011 | not rated yet | 0
- C-sections a critical factor in preterm birth increase May 28, 2008 | not rated yet | 0
- Inducing labor is not associated with higher rates of cesarean sections Jun 20, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Assumptions of Griffith's fracture theory
6 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
Current leading voltage or vice versa concept
8 hours ago Hello, I was wondering if there is a conceptual explanation for when current leads voltage or vice versa for capacitors or inductors with AC...
Angular Frequency of AC voltage
11 hours ago Hello, I am wondering, what is the physical interpretation of the angular frequency of AC voltage? I don't see the physicality of what the angle...
Modeling Rigid Body - Unsure about Euler angles and angular velocity
11 hours ago I'm modeling a single 3D rigid body in preparation for some more complicated modeling in order to gain a better understanding of Euler angles, the...
Function for a bullet's path
13 hours ago I've been mulling this over all weekend, and I've decided to get some help on this. The problem is writing a function to describe a bullet's path....
Elementary questions relating to Newton's laws of motion
14 hours ago i) If a wall breaks when it gets hit by a cannonball, did the wall exert an equal and opposite force on the cannonball? ii) Would the force...
- More from Physics Forums - Classical Physics
More news stories
Nearly three out of four pregnant women experience constipation, diarrhea or other bowel disorders during their pregnancies, a Loyola University Medical Center study has found.
Obstetrics & gynaecology 17 hours ago | not rated yet | 0
New research indicates that women's reproductive function may be tied to their immune status. Previous studies have found this association in human males, but not females.
Obstetrics & gynaecology May 17, 2013 | not rated yet | 0 |
Elsevier today announced the publication of a recent study in Reproductive BioMedicine Online on 5-day old human blastocysts showing that those with an abnormal chromosomal composition can be identified by the rate at whic ...
Obstetrics & gynaecology May 16, 2013 | not rated yet | 0
While global attention has for decades been focused on reducing maternal mortality, population-based data on other causes of death among women of reproductive age has been virtually non-existent. A study conducted by researchers ...
Obstetrics & gynaecology May 14, 2013 | not rated yet | 0
Doctors have terminated the pregnancy of a 23-year-old Turkish woman who was the first ever to receive a uterus transplant from a dead donor, a hospital in southern Turkey said on Tuesday.
Obstetrics & gynaecology May 14, 2013 | not rated yet | 0
(Medical Xpress)—In a recent subgroup analysis of the largest blood pressure treatment trial in history, University of Alabama at Birmingham (UAB) researchers found that women and men react the same to ...
1 hour ago | 5 / 5 (1) | 0
Scientists from Nanyang Technological University (NTU) and Lund University, Sweden, have bioengineered a novel molecule which has been proven to successfully kill tumour cells.
4 minutes ago | not rated yet | 0
Regardless of pain, social class or age, a woman is more likely to be prescribed pain-relieving drugs. A study published in Gaceta Sanitaria (Spanish health scientific journal) affirms that this phenomenon is inf ...
14 minutes ago | not rated yet | 0
An article published on the journal Nature describes the major role that Pyruvate dehydrogenase (PDH) —an enzyme of cellular energy metabolism— plays in the regulation of the cellular senescence induce ...
28 minutes ago | not rated yet | 0
Ten years after the Iraq war of 2003 a team of scientists based in Mosul, northern Iraq, have detected high levels of uranium contamination in soil samples at three sites in the province of Nineveh which, coupled with dramatically ...
1 hour ago | not rated yet | 0
The warning images Brussels proposes to include on tobacco packages in order to reduce consumption do not make the desired impact on smokers because they only find some of them really unpleasant. So, if the ...
54 minutes ago | not rated yet | 0